Thesis. Master of Science. Faculty of Graduate Studies. School of Occupational and Environmental Hygiene.

Abstract:

Glutaraldehyde, a chemical associated with respiratory illness, has been used for
high-level disinfection in hospitals for 40 years. Two substitutes have recently been
introduced — ortho-phthalaldehyde and a mixture of hydrogen peroxide and peracetic
acid — despite limited health effects information about the products. This project used a two-tiered approach to evaluate the risks associated with substitution of high-level disinfectants. It involved predicting the relative toxic effects of all the products and assessing the current practices regarding the use of high-level disinfectants in British Columbia hospitals.
Relative potential toxicities were examined based on regulatory data, a review of the
published literature, and a qualitative structure–activity relationship analysis. There was no published literature and little regulatory data available for ortho-phthalaldehyde and there is no history of using ortho-phthalaldehyde solutions in
any industry. Structure–activity results suggest ortho-phthalaldehyde has dermal and
respiratory sensitizing potential. Although little epidemiological data was available for
hydrogen peroxide or peracetic acid, structure–activity analysis results suggest little risk of sensitization.
Current practices in industry were assessed using a comprehensive survey of current practices and decision processes in all hospitals in British Columbia. Of 95 hospitals, 64 returned surveys; 80% of these used high-level disinfection. Among
user hospitals, 49% used glutaraldehyde only and 51% had introduced alternatives.
Concern about employee health was the most common reason for substituting but
was frequently not considered when choosing specific alternatives. Although occupational health and safety staff were available to 67% of user hospitals, they were involved in the decision process about the use of chemical high-level disinfectants in only 41%. Hospitals that involved occupational health, infection control, or regional staff in high-level disinfectant decisions used glutaraldehyde alternatives less frequently. In most hospitals it was difficult to find any one person knowledgeable about the use of disinfectants at the site.
Despite the fact that little is known about the risks to employees from glutaraldehyde
alternatives, their use is widespread. The potential risks of all high-level disinfectants are serious; thus, regulators are faced with important risk management decisions not only before introducing new chemicals, but also after they have been introduced into the workplace.

Affiliation:

Health and Environment Research (CHER), Centre forOccupational and Environmental Hygiene, School of